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1. What is the primary role of a nurse in a patient-centered medical home (PCMH)?
- A. Coordinate patient care
- B. Administer treatments
- C. Provide health education
- D. Conduct research
Correct answer: A
Rationale: The primary role of a nurse in a patient-centered medical home (PCMH) is to coordinate patient care. Nurses in PCMH settings focus on ensuring continuity of care, managing transitions between different healthcare providers, and facilitating communication among the healthcare team and the patient. Administering treatments, providing health education, and conducting research are important aspects of nursing practice but are not the primary role of a nurse in a patient-centered medical home.
2. A client is postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?
- A. Heart rate of 90/min
- B. Temperature of 37.1°C (98.8°F)
- C. Serosanguineous wound drainage
- D. Urine output of 25 mL/hr
Correct answer: D
Rationale: A urine output of 25 mL/hr is a sign of oliguria, which may indicate dehydration or kidney impairment and should be reported. A heart rate of 90/min is within the normal range (60-100/min) for adults at rest and may be expected postoperatively. A temperature of 37.1°C (98.8°F) is within the normal range (36.1-37.2°C or 97-99°F) and does not indicate an immediate concern. Serosanguineous wound drainage is a common finding postoperatively and indicates a normal healing process.
3. Which of the following is the best available predictor of infant survival and healthy development?
- A. Birth length
- B. Combined Apgar score
- C. Delivery date
- D. Birth weight
Correct answer: D
Rationale: The correct answer is 'Birth weight.' Birth weight is a crucial indicator of an infant's chances of survival and well-being. Low birth weight is associated with various health risks and developmental challenges. Birth length (choice A) is not as significant in predicting infant outcomes as birth weight. The Combined Apgar score (choice B) is a measure of the newborn's health status at birth, not a predictor of long-term survival and development. Delivery date (choice C) is important for determining gestational age but is not as directly related to infant survival and healthy development as birth weight.
4. The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breathe and the nurse’s rapid assessment reveals that the patient’s jugular veins are distended. The nurse should suspect the development of what oncologic emergency?
- A. Increased intracranial pressure
- B. Superior vena cava syndrome (SVCS)
- C. Spinal cord compression
- D. Metastatic tumor of the neck
Correct answer: B
Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein responsible for returning blood from the upper body to the heart, becomes obstructed or compressed, often due to a tumor, such as metastasized breast cancer. SVCS results in impaired venous drainage, leading to symptoms like distended jugular veins, facial swelling, difficulty breathing (dyspnea), and upper body edema. It is a medical emergency that requires prompt intervention to restore blood flow and alleviate symptoms.
5. A patient is prescribed tadalafil (Cialis) for erectile dysfunction. What condition would contraindicate the use of this medication?
- A. History of hypertension
- B. Use of nitrates
- C. Use of antihypertensive medications
- D. History of peptic ulcer disease
Correct answer: B
Rationale: The correct answer is B: 'Use of nitrates.' Tadalafil (Cialis) is contraindicated in patients using nitrates due to the risk of severe hypotension. Nitrates and tadalafil both cause vasodilation, leading to a synergistic effect that can result in a dangerous drop in blood pressure. Choices A, C, and D are incorrect because a history of hypertension, the use of antihypertensive medications, and a history of peptic ulcer disease are not direct contraindications for tadalafil use.
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